OBJECTIVES A female-only HPV vaccination program was implemented in Brazil in 2014 and extended to boys in 2017. The aim of this analysis is to evaluate the effect of increasing the vaccine coverage rate (VCR) on the public health impact and the incremental cost-effectiveness of a gender-neutral vaccination (GNV) quadrivalent HPV vaccine program (4vHPV) in Brazil.

METHODS A validated HPV-type dynamic transmission model was employed to simulate GNV two-dose 4vHPV vaccination in the 9 to 14-year-old female cohort and 11 to 14-year-old male cohort for the prevention of HPV-related cervical cancer (CC), cervical lesions (CIN-1/2/3), and genital warts (GW) over 100 years in Brazil. The model compared current first and second dose VCRs in Brazil (80% and 50% in females/35% and 10% in males) and a higher first and second dose VCRs (80% and 50%) in females and males. ICERs were calculated from cost (USD) and QALYs. Brazil-specific data were used for calibration. The model assumed a 100-year time-horizon, a 5% discount rate, herd immunity, and ongoing cytology screening. The disease management cost savings (DMCS) were calculated subtracting the costs of vaccination from the disease costs avoided.

RESULTS Over 100 years, increasing VCR would avert additional disease cases compared with the current GNV VCR in females: CC (41,092 cases), CIN1 (15,295 cases), CIN2/3 (58,393 cases), HPV6/11-related CIN1 (10,761 cases), and GW (1,587,182 cases), and in males: GW (2,899,069 cases). The incremental cumulative percent reduction in deaths from cervical cancer after 100 years at higher VCR is projected to be 4.9%. The DMCS were USD$44,439,202 over 100 years. The higher first and second dose GNV VCRs (80% and 50%) was highly cost-effective with ICER of USD$1730/QALY.

CONCLUSIONS In Brazil, increasing VCR of 4vHPV in the GNV program would avert additional HPV-related disease cases and be more cost-effective compared with the current GNV VCR.